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Forty-six patients with chronic haematogenous osteomyelitis of the humerus were treated surgically between 1968 and 1987. Operation involved decompression, sequestrectomy and saucerisation, and was always covered by between 10 and 60 days of antibiotic treatment. Forty-three patients were followed up for between 3 months and 20 years, 36 for more than 1 year. Thirty-nine patients achieved healing after one operation and 7 relapsed, of whom 6 healed after a second procedure. [ABSTRACT FROM AUTHOR]

The terms deodorants and antiperspirants very frequently used interchangeably despite the fact that they employ completely different active substances and mechanisms of action. Antiperspirants are necessarily deodorants due to the lack of substrate to decompose. They nevertheless represent a group of very specific substances that create particular problems due to the presence of aluminium chlorohydrate, or ACH, (Al 2 (OH) 5 Cl, 2H 2 O), aluminium sesquichlorohydrate and aluminium-zirconium complex, which, after hydrolysis, causes intense acidification of the skin, hence the importance of inclusion of emollients and pH regulators in formulations. Moreover, systemic aluminium is thought to be genotoxic and to promote breast cancer, and it is thus at the centre of numerous scientific controversies. Nevertheless, its potential toxicity following topical application is related to its ability to penetrate skin, which is as yet poorly understood but considered very low, a fact that may provide some degree of reassurance regarding its use in cosmetic products. Its role in Alzheimer's disease has not been proven. On the other hand, zirconium salts are considered toxic and are partly regulated in Europe. The problems associated with deodorants are those arising from the presence of antiseptics (triclosan, usnic acid) capable of inducing bacterial resistance, but more particularly, the presence of axillary dermatitis due to the allergenic potential of the fragrances and essential oils used (e.g. isoeugenol, citronellal, lyral, cinnamic aldehyde, etc.)., (Copyright © 2020. Published by Elsevier Masson SAS.)

Practically all currently available self-tanning products have as their active ingredient dihydroxyacetone (DHA), which may or may not be combined with erythrulose, tyrosine derivatives, and occasionally a naphthoquinone. The resulting skin tone, which resembles a natural tan, is due to chemical combination of the DHA with amino acids in the skin through the Maillard reaction. Polymer pigments known as melanoidins are formed and are fixed in the stratum corneum, where they remain until corneocyte desquamation occurs. The colouring thus achieved is semi-permanent and is well tolerated by skin. While the formulation of such products is complex and their storage difficult, no other substances provide more satisfactory or more lasting results., (Copyright © 2017. Published by Elsevier Masson SAS.)

According to the knowledge acquired some 15 years ago, the cutaneous lipids may be classified into 2 families: the "neutral" lipids, represented by cholesterol, cholesterol esters, cholesterol sulphate, triglycerides, free fatty acids, squalen and alcanes, and the "polar" lipids including phospholipids (phosphatidylcholine, phosphatidylserine, phosphatidylethanolamine, sphingomyeline) and sphingolipids (ceramides I-VII, monohexosylceramides). From the functional point of view, free fatty acids, cholesterol, and ceramides organised in layers are the most important components of intercellular spaces of the stratum corneum. Analytic methods have been recently developed to help understand the structural organisation of these various molecules within the horny layer and their influence on the epidermal barrier function. Raman microspectroscopy or X-ray diffraction are most frequently used. Differential calorimetry and fluorescence or infrared spectroscopy provide complementary information. The principal findings are: lamellar structure depends on the presence of ceramides supplemented by adequate quantities of free fatty acids and cholesterol; ceramide chains interact to provide the ordered structure and ceramide-1 is necessary for stabilisation of lipid layers; cholesterol may regulate the molecular mobility of hydrocarbon chains within the bi-layers. Knowledge of the molecular structure of the barrier lipids finds several applications, e.g.: in pharmacology--conception of new formulations adapted for percutaneous and topical application of drugs; in dermatology--comprehension of physiopathologic mechanisms of various dermatoses; in biotechnology--development of skin substitutes with valid stratum corneum barrier; in cosmetics--choice of best formulations suited for reconstruction of the intercellular lipid substance.

Introduction: Chronic hematogenous osteomyelitis (C.H.O.) is still a scourge of the non-industrialized countries. The authors operated on 420 cases of C.H.O. in Algeria between 1968 and 1987. A computerized analysis of the results of the surgical treatment of these 420 cases was made in Brussels, Belgium, by two of the authors. The results of this computerized study are exposed., Material and Methods: 67.1 per cent of the patients were male and 37.9 female. 68 per cent were operated before 16 y. of age. 381 lesions involved tubular bones: femur, tibia and humerus were the most frequent locations. Only 4 per cent of the cases had never presented a suppuration. Cultures of Staphylococcus were positive in 82 per cent of the cases. Surgical procedure was classical--bone window opening, sequestrectomy and saucerisation--in 359 cases. Operation was limited to soft tissues in 22 cases and bone resection was performed in 39 cases. Post-operative antibiotherapy was administered for a period of 10 to 60 days according to the patients., Results: After the first operation with the classical procedure, results were satisfactory in 72 per cent of the cases but "healing" was achieved in 95 per cent of the cases after 2, 3, 4 and up to 6 operations. After bone resection, the rate of permanent healing was of 100 per cent. Follow-up was of more of 1 year (up to 22 y.) in 80 per cent of the cases., Discussion: As far as classical procedure is concerned, a computerized analysis made according to 34 variables, led to the conclusions that the following variables could have a positive influence upon the prognosis: surgical team's experience, young age of the patient at the time of operation, subacute onset of the disease, location on the humerus, diaphysis of long bones, membranous and short bones, small number of sinuses, sclero-geodic radiologic appearance of the lesions, thin perifocal radiologic condensation, periosteal reaction, post-operative administration of two antibiotics. Excellent results of bone resection are pointed out but attention is drawn on the dangers of extending the indications for resection to the tubular bones., Conclusion: The authors conclude that improvement in the results of the surgical treatment of C.H.O. may only take place after improvement of the quality and duration of chemotherapy: that is confirmed by the results of a clinical trial they organized on the role of post-operative administration of Amoxicilline + Clavulanic Acid for a period of 60 days after surgery: 44 patients, 2 lost to follow-up, 4 failures and 38 "healings" (90.5 per cent) at 2 years and more.

Between 1968 and 1987 the authors treated 165 cases of chronic haematogenous osteomyelitis of the femur by operation. The procedure used combined decompression, sequestrectomy and saucerization in 161 cases, and sequestrectomy alone in 4. Chemotherapy was used in association for between 10 and 60 days. Eleven patients, thought to be healed, were lost to follow-up after 4 months. The remainder were reviewed for between 4 and 252 months, 124 for more than one year. After the first operation 105 lesions (64%) healed completely, while 60 (36%) relapsed. Of these, 48 were treated by further operation and 12 by drainage of the abscess. Nine patients relapsed twice and there were 3 or more relapses in a further 9. When last seen, 147 lesions were healed and 18 had a permanent sinus. Special features in relation to the femur are discussed, including destructive lesions of the knee and hip joints, the high incidence of stiffness of the knee even in the absence of radiographic evidence of destruction (48.5%), and the danger of injuries to the femoral vessels when using an approach through a medial sinus. The frequency of occurrence of lesions on both medial and posterior aspects of the femur has led the authors to recommend definitive surgical approaches, especially the true postero-lateral and antero-medial routes. Unsatisfactory results after operation may be due to the difficulty in performing sequestrectomy in deep and extensive lesions, problems in undertaking adequate saucerization and the lack of muscle to fill the residual cavity.

In two prospective clinical trials, the authors treated 83 chronic osteomyelitis from various origins by sequestrectomy completed with insertion of Plaster of Paris pellets impregnated with antibiotics. After a review of the experimental and clinical reports on the subjects, the authors give their results: 61.5% of healings and 38.5% of failures. Because of the small number of cases, it was not possible to find out an explanation for this fair results. However wide extension of the lesions, which is frequent in chronic haematogenous osteomyelitis, seems to be a contraindication to the technics. The authors conclude to the necessity of carrying up new experiments with new antibiotics and large series of patients in order to point out the righted indications of the method.

Thirty-six cases of tuberculosis of the elbow have been treated by chemotherapy and plaster cast immobilisation followed by rehabilitation. The overall results were satisfactory with restoration of useful mobility and flexion in 26 cases. The ranges of movement in pronation and supination were less satisfactory.

The authors have applied conservative treatment in 21 cases of tuberculosis of the elbow with 12 months of specific chemotherapy and antibiotics and plaster immobilization for 3 montths followed by rehabilitation. Four elbows were ankylosed at the end of treatment. Seventeen elbows had useful joint mobility. In thirteen cases, there was more than 70 degrees of movement in flexion but the results were not so satisfactory as regards pronation and supination. The authors believe that conservative management gives better results than surgery by arthrodesis or resection.

We have carried out a retrospective study of 49 cases of tuberculosis of the hip in adults, all treated by one of the authors. All patients presented with destructive lesions in the hip. Abscess formation and sinuses were infrequent. A scientific diagnosis was obtained in 46 cases. All the patients were treated with chemotherapy for 6 to 12 months. The hip was immobilised for 3 months, either by skeletal traction followed by a plaster cast, or by a cast alone, depending on the need for correction of deformity. If deformity was fixed or absent, immobilisation was not undertaken. A favourable response to chemotherapy was observed in all 40 patients who were available for follow up. One relapsed after 12 months. Some hips progressed to total bony fusion, with the remainder showing either complete or moderate stiffness. The functional result depended on the presence of pain and the degree of deformity, and the need for surgery was determined by these two factors. Corrective osteotomy or arthrodesis have been performed. The indications for operation are discussed considering the sex, occupation and needs of the patient. The place of excision arthroplasty and of total replacement is examined.

During the past 8 years the authors have seen 47 old dislocations of the elbow. In 16 instances, function was acceptable with more than 90 degrees flexion and in 31 it was not acceptable. Twenty five elbows were operated on with 23 satisfactory results and 2 stiff elbows. The importance of long-term rehabilitation is stressed. Reduction achieved a better position of the elbow but only slight improvement in the range of movement. The need for surgical reduction should only be considered after several months of rehabilitation since some older cases can be improved without surgery. More recent cases should be operated on as soon as possible.

The authors have operated on 106 cases of chronic haematogenous osteomyelitis. On 83 occasions the surgical procedure was on the bone itself and in 23 only on the soft tissues. After a one-stage bone drilling with sequestrectomy and saucerisation the results wee satisfactory in 60 p. 100 of cases. Healing was achieved in 93 p. 100 of cases after a second, third or fourth surgical procedure. An analysis of the results has led to the following conclusion; the prognosis is better in girls, in the humerus, when the onset of the disease was subacute or when it had been present for less than 1 year.

One hundred and seventy-one patients suffering from Pott's disease of the spine were treated by the same surgeons between 1965 and 1985. Chemotherapy, which varied during the period, was given in every case. Plaster immobilization was only used in the first 41 patients, until the authors concluded that it did not prevent worsening of the kyphosis. For technical reasons, surgical treatment was not used in any of these 171 patients. The results showed, in children, not only the usual development of kyphosis in the course of treatment but worsening later in the course of growth. For this reason, arthrodesis by the anterior route should be considered to obtain early fusion when the facilities and technical skills are available. In adults, the indications for surgery are more limited. Whilst there is a risk that kyphosis may reach a mean of 20 degrees during conservative treatment, it does not increase later. The authors conclude that it is necessary to link the indications for surgery to the availability of facilities at each individual hospital called upon to treat these patients.

The authors define some limits for useful concentrations of propylene glycol (P.G.) by determination of inhibition produced in cell respiration from (crushed) mouse liver and in human cutaneous fibroblastic proliferation. They conclude that P.G. is able to inhibit both these physicological mechanisms from concentration as weak as 5.5% and 2% respectively. They give a method for analytical determination of P.G. in cosmetic and pharmaceutical products using gas liquid chromatography. This method is useful for a wide range of concentrations.

Forty-six patients with chronic haematogenous osteomyelitis of the humerus were treated surgically between 1968 and 1987. Operation involved decompression, sequestrectomy and saucerisation, and was always covered by between 10 and 60 days of antibiotic treatment. Forty-three patients were followed up for between 3 months and 20 years, 36 for more than 1 year. Thirty-nine patients achieved healing after one operation and 7 relapsed, of whom 6 healed after a second procedure.